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Compagne C, Gabriel D, Ferrero L, Magnin E, Tannou T. Tools for the Assessment of Risk-Taking Behavior in Older Adults with Mild Dementia: A Cross-Sectional Clinical Study. Brain Sci 2023; 13:967. [PMID: 37371445 DOI: 10.3390/brainsci13060967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Diseases such as Alzheimer's cause an alteration of cognitive functions, which can lead to increased daily risk-taking in older adults living at home. The assessment of decision-making abilities is primarily based on clinicians' global analysis. Usual neuropsychological tests such as the MoCA (Montreal Cognitive Assessment) cover most of the cognitive domains and include mental flexibility tasks. Specific behavioral tasks for risk-taking, such as the Balloon Analogue Risk Task (BART) or the Iowa Gambling Task (IGT), have been developed to assess risk-taking behavior, particularly in the field of addictology. Our cross-sectional study aims to determine whether the MoCA global cognitive assessment could be used as a substitute for behavioral tasks in the assessment of risky behavior. In the current study, 24 patients (age: 82.1 ± 5.9) diagnosed with mild dementia completed the cognitive assessment (MoCA and executive function assessment) and two behavioral risk-taking tasks (BART, simplified version of the IGT). Results revealed no relationship between scores obtained in the MoCA and behavioral decision-making tasks. However, the two tasks assessing risk-taking behavior resulted in concordant risk profiles. In addition, patients with a high risk-taking behavior profile on the BART had better Trail Making Test (TMT) scores and thus retained mental flexibility. These findings suggest that MoCA scores are not representative of risk-taking behavioral inclinations. Thus, additional clinical tests should be used to assess risk-taking behavior in geriatric settings. Executive function measures, such as the TMT, and behavioral laboratory measures, such as the BART, are recommended for this purpose.
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Affiliation(s)
- Charline Compagne
- UR LINC, Université de Franche-Comté, 25 000 Besançon, France
- CIC-1431 INSERM, Centre Hospitalier Universitaire, 25 000 Besançon, France
| | - Damien Gabriel
- UR LINC, Université de Franche-Comté, 25 000 Besançon, France
- CIC-1431 INSERM, Centre Hospitalier Universitaire, 25 000 Besançon, France
- Plateforme de Neuroimagerie Fonctionnelle Neuraxess, 25 000 Besançon, France
| | - Lénaïc Ferrero
- CIC-1431 INSERM, Centre Hospitalier Universitaire, 25 000 Besançon, France
| | - Eloi Magnin
- UR LINC, Université de Franche-Comté, 25 000 Besançon, France
- CHU Département de Neurologie, Centre Hospitalier Universitaire, 25 000 Besançon, France
| | - Thomas Tannou
- UR LINC, Université de Franche-Comté, 25 000 Besançon, France
- Plateforme de Neuroimagerie Fonctionnelle Neuraxess, 25 000 Besançon, France
- CIUSS Centre-Sud de l'Ile-de-Montréal, Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC H3W 1W5, Canada
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Fusi G, Crepaldi M, Palena N, Segatta C, Bariselli M, Cerrano C, Rusconi ML, Vascello MGF. Decision-making abilities under risk and ambiguity in adults with traumatic brain injury: what do we know so far? A systematic review and meta-analysis. J Clin Exp Neuropsychol 2023; 45:389-410. [PMID: 37585702 DOI: 10.1080/13803395.2023.2245107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/21/2023] [Indexed: 08/18/2023]
Abstract
Traumatic brain injury (TBI) is a major health and socio-economic problem since it is one of the major sources of death and disability worldwide. TBI patients usually show high heterogeneity in their clinical features, including both cognitive and emotional/behavioral alterations. As it specifically concerns cognitive functioning, these patients usually show decision-making (DM) deficits. DM is commonly considered a complex and multistep process that is strictly linked to both hot and cold executive functioning and is pivotal for daily life functioning and patients' autonomy. However, the results are not always in agreement, with some studies that report huge alterations in the DM processes, while others do not. The present systematic review and meta-analysis aims to integrate past literature on this topic, providing a clear and handy picture both for researchers and clinicians. Thirteen studies addressing domain-general DM abilities were included from an initial N = 968 (from three databases). Results showed low heterogeneity between the studies (I2 = 7.90, Q (12) = 13.03, p = .37) supporting the fact that, overall, TBI patients showed lower performance in DM tasks as compared to healthy controls (k = 899, g = .48, 95% CI [0.33; 0.62]) both in tasks under ambiguity and under risk. The evidence that emerged from this meta-analysis denotes a clear deficit of DM abilities in TBI patients. However, DM tasks seemed to have good sensitivity but low specificity. A detailed description of patients' performances and the role of both bottom-up, hot executive functions and top-down control functions have been further discussed. Finally, future directions and practical implications for both researchers and clinicians have been put forward.
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Affiliation(s)
- Giulia Fusi
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Maura Crepaldi
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Nicola Palena
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Cecilia Segatta
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Martina Bariselli
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Costanza Cerrano
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Maria Luisa Rusconi
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
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Lai RY, Desai NA, Amlang CJ, Lin CYR, Chen TX, Minyetty MJ, Amokrane N, Kuo SH. Gambling associated risk-taking decision in cerebellar ataxia. Parkinsonism Relat Disord 2023; 107:105252. [PMID: 36577359 PMCID: PMC9905314 DOI: 10.1016/j.parkreldis.2022.105252] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/09/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION People with cerebellar ataxia (CA) can develop impulsive and compulsive behaviors that significantly affect their and their family's quality of life. To further assess the decision-making process associated with these behaviors, we used the Iowa Gambling Task (IGT) to study people with CA. METHODS Sixty individuals with CA and thirty age-matched controls were enrolled in the study to complete the IGT. No participants had a prior or comorbid neurologic or psychiatric disorder associated with impulsivity. IGT performance in each of the five 20-trial blocks was compared between groups and the progression of participants' performance was assessed with simple linear regression models. Subgroup analyses were performed with genetic and non-genetic CA cases. RESULTS CA cases obtained significantly lower IGT total scores than controls (-5.30 ± 37.53 vs. 21.30 ± 37.37, p = 0.004). In addition, those with CA made riskier decisions throughout the task compared to controls. Although both CA and controls learned to make decisions with more favorable outcomes over the course of completing the IGT, CA participants never matched the controls' performance. IGT performance did not correlate with ataxia severity or depressive symptoms. CONCLUSION The IGT may capture a unique behavioral symptom of CA. Future studies may help elucidate the mechanisms underlying impaired decision-making in CA and further the understanding of a broader spectrum of cerebellar cognitive affective syndrome.
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Affiliation(s)
- Ruo-Yah Lai
- Department of Neurology, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA; Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA
| | - Natasha A Desai
- Department of Neurology, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA; Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA
| | - Christian J Amlang
- Department of Neurology, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA; Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA
| | - Chi-Ying R Lin
- Alzheimer's Disease and Parkinson's Disease Centers, Department of Neurology, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX, 77030, USA
| | - Tiffany X Chen
- Department of Neurology, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA; Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA; Department of Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, 3400 N Charles St, Baltimore, MD, 21218, USA
| | - Michael J Minyetty
- Department of Neurology, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA; Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA
| | - Nadia Amokrane
- Department of Neurology, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA; Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA; Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA.
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4
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Gaubert F, Borg C, Chainay H. Decision-Making in Alzheimer's Disease: The Role of Working Memory and Executive Functions in the Iowa Gambling Task and in Tasks Inspired by Everyday Situations. J Alzheimers Dis 2022; 90:1793-1815. [PMID: 36336931 DOI: 10.3233/jad-220581] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) negatively impacts patients' ability to make advantageous decisions, i.e., a core ability contributing to the preservation of autonomy. OBJECTIVE The present study aims to analyze the changes that occur in the decision-making competence (DMC) in AD patients and to determine if these changes are related to the deterioration of executive functions and working memory. METHOD To this end, 20 patients with AD and 20 elderly control adults were assessed using executive, working memory, and DMC tasks. The latter comprised the Iowa Gambling Task (IGT) and a scenarios task based on situations inspired by everyday life and performed under conditions of risk and ambiguity. RESULTS Results revealed lower performances in AD patients than in elderly control adults for all the tasks assessing cognitive functions. The AD patients also made more strategy changes during the IGT. In the scenarios tasks, the two groups took as many ambiguous or risky decisions, but AD patients tended to take more risks in the context of gain than elderly control adults did. Switching and updating ability, as well as working memory, appeared to be involved in decisions in tasks inspired by everyday life, while inhibition was more related to the IGT performances. CONCLUSION Working memory and executive functions seem to be involved in decision-making, but in different ways in gambling and daily-life situations.
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Affiliation(s)
- Fanny Gaubert
- Etude des Mécanismes Cognitifs Laboratory, Lyon 2 University, Bron, France
| | - Céline Borg
- Etude des Mécanismes Cognitifs Laboratory, Lyon 2 University, Bron, France.,University Hospital of Saint-Etienne, Hôpital Nord, Saint-Etienne, France.,Psychology Faculty, Catholic University of Lyon, Lyon, France.,Laboratoire de Psychologie et Neurocognition, University of Grenoble Alpes, Saint-Martin-d'Hères, France
| | - Hanna Chainay
- Etude des Mécanismes Cognitifs Laboratory, Lyon 2 University, Bron, France
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5
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Sun W, Matsuoka T, Narumoto J. Decision-Making Support for People With Alzheimer's Disease: A Narrative Review. Front Psychol 2021; 12:750803. [PMID: 34867639 PMCID: PMC8633444 DOI: 10.3389/fpsyg.2021.750803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/25/2021] [Indexed: 01/01/2023] Open
Abstract
The proportion of people with dementia has been increasing yearly, and the decision-making capacity of these people has become a major concern in fields such as the financial industry and in medical settings. In this narrative review, we discuss decision-making in people with Alzheimer’s disease (AD), and we propose the support for decision-making in people with AD, especially financial and medical decision-making. We summarize several hypotheses and theories on the decision-making capacity of people with AD. These include the frontal lobe hypothesis, physiological theory, dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, and the Person-Task-Fit (PTF) framework. Both internal and external factors can affect decision-making by people with AD. Internal factors are affected by changes in the brain and neurotransmitters, as well as alterations in cognitive ability and emotion. External factors include task characters, task contents, and situation influence. Since feedback has a significant effect on decision-making capacity, a series of suggestions may be helpful to improve this capacity, such as explicit advice, simple options, pleasant rewards, the Talking Mats approach, memory and organizational aid, support by caregivers, cognitive training and feedback. Thus, in providing decision-making support for people with AD, it is important to identify the internal and external factors that impair this process and to deal with these factors.
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Affiliation(s)
- Weiyi Sun
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Fernandes C, Macedo I, Barbosa F, Marques-Teixeira J. Economic decision-making in the continuum between healthy aging and Alzheimer's Disease: A systematic review of 20 years of research. Neurosci Biobehav Rev 2021; 131:1243-1263. [PMID: 34715151 DOI: 10.1016/j.neubiorev.2021.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/23/2021] [Accepted: 10/23/2021] [Indexed: 01/21/2023]
Abstract
The effect of pathological aging on economic decision-making is a topic of major relevance as impairments in this domain place older adults at increased risk for financial abuse. This review aims to characterize decision-making across the continuum that goes from healthy aging to Alzheimer's Dementia. We included 42 studies comparing patients with Mild Cognitive Impairment (MCI) and healthy older adults, patients with Alzheimer's Disease (AD) and healthy older adults, and patients with MCI and patients with AD. Substantial evidence emerged suggesting that both MCI as AD affect economic decision-making. However, a non-negligible number of behavioural tasks failed to find significant differences between patients and controls, and no differences were reported between patients with MCI and AD. On the contrary, measures of financial capacity reached more robust findings, showing that healthy older adults had better performance than patients, while MCI patients showed better performance than AD patients. This review presents the main conclusions that may be drawn from significant findings, as well as the hypotheses and recommendations for future research.
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Affiliation(s)
- Carina Fernandes
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Portugal.
| | - Inês Macedo
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Portugal
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Portugal
| | - João Marques-Teixeira
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Portugal
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7
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Perach R, Rusted J, Harris PR, Miles E. Emotion regulation and decision-making in persons with dementia: A scoping review. DEMENTIA 2021; 20:1832-1854. [PMID: 33226266 PMCID: PMC8216314 DOI: 10.1177/1471301220971630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Emotion is integral to decision-making, and emotion regulation is associated with improved well-being in older age. Persons with dementia are likely to experience impairments in emotion regulation processes that can potentially contribute to differential decision-making and well-being outcomes. To promote the development of theoretical models of well-being in dementia, we review the quantitative evidence concerning the associations between emotion regulation and decision-making in dementia. METHODS Scoping review. RESULTS Seven studies of persons with dementia met our criteria. In persons with frontotemporal lobar degeneration, emotion regulation processes that precede the emotional experience were associated with decision-making in a moral (but not uncertainty) context. Independent of type of dementia, evidence concerning the associations between emotion regulation processes that occur after emotion is experienced and decision-making was mixed and drew on different methodologies. No studies relating to the associations between decision-making in dementia and several emotion regulation processes and strategies were found. CONCLUSIONS In this review, we sought to clarify the concept of everyday decision-making in dementia and map the current state of evidence concerning its associations with emotion regulation. Our findings show that emotion regulation processes are associated with decision-making in dementia, depending on type of decision-making assessment and emotional experience. We outline the gaps in the literature to set a research agenda for promoting our understanding of how emotion regulation processes can shape the various decisions that are made by persons with dementia on a daily basis.
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Affiliation(s)
- Rotem Perach
- School of Psychology, University of Sussex, Brighton, UK
| | | | | | - Eleanor Miles
- School of Psychology, University of Sussex, Brighton, UK
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8
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Gaubert F, Chainay H. Decision-Making Competence in Patients with Alzheimer's Disease: A Review of the Literature. Neuropsychol Rev 2021; 31:267-287. [PMID: 33576942 DOI: 10.1007/s11065-020-09472-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
Decision-making competence (DMC) appears to be influenced by the congruency between the characteristics of the individual, the task and the context. Indeed, the ability to make decisions seems to be highly sensitive to cognitive changes as observed, in particular, in the healthy elderly. Few studies have investigated these relations in pathological ageing. In this review, we focus on DMC in patients with Alzheimer's disease (AD) and the links its impairment could have with deficits in episodic memory, working memory, and executive functions. Decision-making under risk and under ambiguity appears to be impaired early in the progress of AD, with the deficit being greater during the later stages of the disease. In addition, some studies suggest that the impairment of DMC is exacerbated by deficits in other cognitive functions, in particular working memory and executive functions. This degradation in the ability to make decisions seriously affects the quality of life of patients and their relatives, since they frequently face important decisions, especially concerning healthcare, finance or accommodation. Thus, the growing incapacity to decide for themselves increases patients' and caregivers' stress and burden. The challenge for future studies is to determine how best to help patients and their families in the decisional process.
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Affiliation(s)
- Fanny Gaubert
- Laboratoire d'Etude des Mécanismes Cognitifs, Université Lyon 2, 5 avenue Pierre Mendès France, 69676, Bron, France.
| | - Hanna Chainay
- Laboratoire d'Etude des Mécanismes Cognitifs, Université Lyon 2, 5 avenue Pierre Mendès France, 69676, Bron, France
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9
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How does decisional capacity evolve with normal cognitive aging: systematic review of the literature. Eur Geriatr Med 2020; 11:117-129. [PMID: 32297227 DOI: 10.1007/s41999-019-00251-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Aging is associated with increased needs related to complex decisions, particularly in medical and social issues. However, the complexity of decision-making involves many neurological functions and structures which are potentially altered by cognitive aging. METHODOLOGY A systematic review was conducted in accordance with PRISMA guidelines to examine changes in decision-making occurring in normal cognitive aging. The keywords "decision making" and "normal aging" were used to find the clinical studies and literature reviews focused on these changes. RESULTS A total of 97 articles were considered in the review, and ultimately 40 articles were selected, including 30 studies and 10 literature reviews. The data from these studies were of uneven quality and too disparate to allow meta-analysis according to PRISMA criteria. Nevertheless, a key result of the analysis is the decrease of processing speed with aging. In ambiguous decision-making situations, the alteration of the ventromedial system is associated with changes in motivation profiles. These changes can be compensated by experience. However, difficulties arise for older adults in the case of one-off decisions, which are very common in the medical or medico-social domains. CONCLUSIONS Cognitive aging is associated with a slowdown in processing speed of decision-making, especially in ambiguous situations. However, decision-making processes which are based on experience and cases in which sufficient time is available are less affected by aging. These results highlight the relativity of decision-making capacities in cognitive aging.
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Wang H, Fan Z, Shi C, Xiong L, Zhang H, Li T, Sun Y, Guo Q, Tian Y, Qu Q, Zhang N, Cheng Z, Wu L, Wu D, Han Z, Tian J, Xie H, Tan S, Gao J, Luo B, Pan X, Peng G, Qin B, Tang Y, Wang K, Wang T, Zhang J, Zhao Q, Gauthier S, Yu X. Consensus statement on the neurocognitive outcomes for early detection of mild cognitive impairment and Alzheimer dementia from the Chinese Neuropsychological Normative (CN-NORM) Project. J Glob Health 2020; 9:020320. [PMID: 31893029 PMCID: PMC6925962 DOI: 10.7189/jogh.09.020320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Huali Wang
- Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, Beijing, China.,National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Zili Fan
- Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, Beijing, China.,National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Chuan Shi
- National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China.,Department of Clinical Psychological Assessment, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
| | - Lingchuan Xiong
- Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, Beijing, China.,National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Haifeng Zhang
- Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, Beijing, China.,National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Tao Li
- Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, Beijing, China.,National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Yongan Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Qihao Guo
- Department of Geriatrics, Shanghai Sixth Hospital, Shanghai, China
| | - Yanghua Tian
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Qiumin Qu
- Department of Neurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Nan Zhang
- Department of Neurology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Zaohuo Cheng
- Wuxi Mental Health Center, Nanjing Medical University, Wuxi, China
| | - Liyong Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Daxing Wu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zaizhu Han
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Jinzhou Tian
- Beijing Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hengge Xie
- Department of Neurology, China PLA General Hospital, Beijing, China
| | - Shuping Tan
- Beijing Huilongguan Hospital, Beijing, China
| | - Jingfang Gao
- Zhejiang University of Traditional Chinese Medicine First Affiliated Hospital, Hangzhou, China
| | - Benyan Luo
- Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoping Pan
- Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Guoping Peng
- Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Qin
- Beijing Hospital, National Health Commission, Beijing, China
| | - Yi Tang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kai Wang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tao Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Junjian Zhang
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Qianhua Zhao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Serge Gauthier
- McGill Center for Studies in Aging, McGill University, Montreal, Canada
| | - Xin Yu
- Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, Beijing, China.,National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
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11
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Sun T, Xie T, Wang J, Zhang L, Tian Y, Wang K, Yu X, Wang H. Decision-Making Under Ambiguity or Risk in Individuals With Alzheimer's Disease and Mild Cognitive Impairment. Front Psychiatry 2020; 11:218. [PMID: 32256419 PMCID: PMC7093589 DOI: 10.3389/fpsyt.2020.00218] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 03/05/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Making advantageous decisions is essential in everyday life. Our objective was to assess how patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) make decisions under conditions of ambiguity or risk. In addition, the study also aimed to examine the relationship between decision-making competence and memory and executive function. METHODS Patients with MCI (n = 36) and AD (n = 29) and healthy elderly controls (HC, n = 34) were recruited from the memory clinic. All subjects were administered a comprehensive neuropsychological battery test. We used the Iowa Gambling Task (IGT) to measure decision-making under ambiguity and the Game of Dice Task (GDT) to measure decision-making under risk. Pearson's correlation was used to examine the relationship between the performance of IGT and GDT with delayed recall and the Stroop test. RESULTS In the GDT, MCI and AD patients presented similar performance but showed different patterns when compared with the HC group. The proportion of those making advantageous choices was lower in the AD group than in the HC group (p = 0.01), while the MCI and HC groups did not differ (p = 0.14). Meanwhile, concerning the ratio of accepting negative feedback, the AD (p < 0.01) group was significantly different from the HC patients, but the MCI (p = 0.06) and HC groups did not differ. In the IGT, MCI and AD patients selected randomly from advantageous and disadvantageous decks (p = 0.94 and p = 0.54), showing no significant change in performance over time. In contrast, the HC group made increasingly frequent advantageous selections over time (p = 0.04). Furthermore, the proportion of advantageous decision-makers for the GDT had a linear relationship with delayed recall of the Hopkins Verbal Learning Test and Stroop color words (p < 0.01 and p < 0.01, respectively). CONCLUSION Our findings suggest that decision-making ability under ambiguity is compromised in MCI and AD, and the decision-making under risk is only impaired in AD. Reduced decision-making performance under risk is closely correlated with lower executive functions and memory.
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Affiliation(s)
- Tingting Sun
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, Beijing, China.,National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Teng Xie
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, Beijing, China.,National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Jing Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, Beijing, China.,National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Long Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xin Yu
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, Beijing, China.,National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, Beijing, China.,National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
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